Clinical experience with polymethylmethacrylate microspheres (Artecoll) for soft-tissue augmentation: a retrospective review.

OBJECTIVE: To evaluate patient satisfaction and clinical outcomes with soft-tissue augmentation using an injectable alloplast composed of polymethylmethacrylate microspheres 30 to 40 microm in diameter suspended in atelocollagen (3.5% collagen solution) (Artecoll; Artes Medical Inc, San Diego, California).

DESIGN: A retrospective review of the literature and an evaluation of our clinical experience with Artecoll implantation for facial soft-tissue augmentation were performed. In a large private metropolitan clinical facial plastic surgery practice, 72 patients (62 females and 10 males) underwent Artecoll implantation between January 1, 1997, and June 30, 2002. Artecoll was implanted into different facial sites, including the philtrum, acne scars, corners of the mouth, upper and lower lips, melolabial folds (also known as nasolabial folds), and other facial creases to attain permanent soft-tissue augmentation. Via completion of an anonymous survey, patients performed subjective evaluation of the aesthetic results. Subjective evaluation of aesthetic results by the surgeon was based on review of photographic documentation. Objective variables, including complications, sites most often treated, total number of treatments, and volume of implant material injected, were obtained by reviewing patient medical records.

RESULTS: Among 72 patients, 40 returned a completed patient satisfaction survey (56% response rate). The most common reason cited by patients (35 of 40) for selecting Artecoll implantation was that the implantation offered permanent correction. Five of 40 patients reported persistent problems with Artecoll (firmness of the lip in 1 patient, increased sensitivity of the lip for 6 months in 1 patient, and lumps in their lips in 3 patients). Eighty-five percent of patients (34 of 40) reported that the treatment met or exceeded their expectations, 13% (5 of 40) reported that the treatment was less satisfying than expected, and 3% (1 of 40) reported that the treatment was much less satisfying than expected. Ninety-five percent (38 of 40) reported that they would recommend Artecoll implantation to a friend or relative, and 90% (36 of 40) reported that they would undergo Artecoll implantation again. The retrospective medical record review revealed that the most commonly requested facial areas for augmentation were (in order of frequency) upper lip, lower lip, melolabial folds, corners of the mouth, and other facial creases. Seventy-two patients underwent 177 Artecoll implantation procedures. The mean number of treatments required to obtain favorable soft-tissue augmentation was 2.4. The medical record review confirmed that 5 of 72 patients had complications after Artecoll implantation (nodule formation in 4 patients and persistent lip pain in 1 patient). Sixty-two of 72 patients (86%) achieved favorable soft-tissue augmentation with a total Artecoll implant volume of 3.0 mL or less.

CONCLUSIONS: Artecoll is a satisfying treatment for lip augmentation or for treatment of facial creases and furrows among patients seeking permanent correction. However, implantation success is technique sensitive. Conservative gradual implantation provides favorable results and few complications. Implantation in the subdermal plane is critical to obtain favorable outcomes using this injectable alloplast.